Marymount Primary Care Services, Inc

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

Legal business name

MARYMOUNT PRIMARY CARE SERVICES, INC

Practice address

17747 Chillicothe Rd
Suite 100
Chagrin Falls, OH 44023-4739

Phone

(440) 543-8855

Fax

(440) 543-2470

NPI assigned

Jan 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Peter P Walchanowicz

Title

Practice Manager

Phone

(440) 543-8855

Specialties & licenses 5

Addresses

Other identifiers 2

Networks

• devoted network organization-2d523d8e-e8f9-454a-bcd3-333df65bdbe8Plans: DEVOTED CORE 023 PA (HMO) (H6852-023-000, H6852); DEVOTED GIVEBACK 009 PA (HMO) (H6852-009-000, H6852); DEVOTED CORE 010 PA (HMO) (H6852-010-000, H6852); DEVOTED CORE 008 PA (HMO) (H6852-008-000, H6852); DEVOTED GIVEBACK 011 PA (HMO) (H6852-011-000, H6852); DEVOTED GIVEBACK 013 PA (HMO) (H6852-013-000, H6852); DEVOTED CORE 014 PA (HMO) (H6852-014-000, H6852); DEVOTED GIVEBACK 015 PA (HMO) (H6852-015-000, H6852); DEVOTED CORE 012 PA (HMO) (H6852-012-000, H6852)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1023089653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17747 CHILLICOTHE RD",
            "address_2": "SUITE 100",
            "city": "CHAGRIN FALLS",
            "state": "OH",
            "postal_code": "440234739",
            "telephone_number": "440-543-8855",
            "fax_number": "440-543-2470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17747 CHILLICOTHE RD",
            "address_2": "SUITE 100",
            "city": "CHAGRIN FALLS",
            "state": "OH",
            "postal_code": "440234739",
            "telephone_number": "440-543-8855",
            "fax_number": "440-543-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT PRIMARY CARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "WALCHANOWICZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "440-543-8855",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000028432",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0139719",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark C. Brown, PHD,LLC
• Tara Odams Marnin, OTR/L
• Jane Marie Maroun
• Marymount Care Services LLC
• Marymount Primary Care Services Inc
• Massey Physical Therapy LLC
• Andrea Matanovic, MOT, OTR/L
• Kathleen S Maxwell, MSW, LISW-S
• Loraine M Mazzolini, INHC
• Kelly L McClintock, DDS

• All providers in Chagrin Falls, OH
• Occupational Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.